Methods for diagnosing gastritis. Diagnosis of chronic gastritis: what is the patient examination plan? The main method for diagnosing chronic gastritis

Gastritis is the most common disease of the gastrointestinal tract. Patients often make this diagnosis themselves. You can often hear: “I have a pain in the pit of my stomach, heaviness in my stomach, which means I have gastritis.”

Term gastritis used to designate inflammatory and structural changes in the gastric mucosa of different course and origin. Gastritis is a difficult diagnosis.

It is the structural changes in the gastric mucosa that occur with impaired recovery (or regeneration), as well as atrophy (reduction in volume) of epithelial cells of the gastric mucosa and the replacement of normal glands with fibrous tissue (or fibrous tissue, which is no longer able to perform its secretory function) that is called gastritis, a disease that usually lasts a long time.

However, gastritis is a morphological diagnosis (a diagnosis in which there are structural changes) and clinically it may be asymptomatic.

Or may have the following symptoms.

In the first place for this diagnosis is pain syndrome. Pain is the first and main symptom that worries patients the most and forces them to see a doctor. Pain occurs in the epigastric (or epigastric) region, it usually occurs 1.5 - 2 hours after eating, it can be sharp, strong or dull pressing.

There is also the so-called dyspeptic syndrome which is observed in most patients. Patients experience a burning sensation in the epigastric region (or heartburn) and sour belching, which indicates the reflux of stomach contents into the esophagus (reflux), and there may also be nausea and vomiting during exacerbation.

But it may also be that the patient has many complaints, but there are no structural changes, then they talk about functional dyspepsia.

Gastritis is divided into acute and chronic.

Acute gastritis

Acute gastritis - acute inflammation of the gastric mucosa that occurs when exposed to poor quality food or the use of certain medications. Acute gastritis, in turn, is divided into catarrhal, fibrinous, corrosive and phlegmonous.

1. Catarrhal gastritis is an acute inflammation of the gastric mucosa after a single intake of poor quality food, systematic malnutrition, and severe stress.
2. Fibrinous gastritis (diphtheritic) is an acute gastritis that is characterized by diphtheritic inflammation of the gastric mucosa. Occurs in severe infectious diseases, poisoning with sublimate, acids.
3. Corrosive gastritis (necrotic gastritis) is an acute gastritis with necrotic tissue changes that develops when concentrated acids or alkalis enter the stomach.
4. Phlegmonous gastritis is acute gastritis with purulent inflammation of the stomach wall. Occurs during injuries, as a complication of gastric ulcer.

Chronic gastritis

Chronic gastritis - long-term inflammatory damage to the gastric mucosa, which occurs with its structural restructuring and disruption of the secretory (acid- and pepsin-forming), motor and endocrine (synthesis of gastrointestinal hormones) functions of the stomach.

Classification depending on the cause:

1. Helicobacter pylori gastritis (gastritis in which Helicobacter pylori is found in the body, a spiral-shaped bacterium that infects various parts of the stomach and duodenum). With this type of gastritis, the entrance section of the stomach (antrum, see figure) is usually affected.
2. Autoimmune gastritis of the body of the stomach
3. Chronic reflux gastritis
4. Radiation, infectious gastritis, etc. (not related to Helicobacterрylorі)

Classification of gastritis based on types of secretion

1. Gastritis with increased secretion
2. Gastritis with normal secretion
3. Gastritis with secretory insufficiency

By localization gastritis is divided into

1. Antral (gastritis of the pyloric or outlet region, see figure)
2. Fundal (gastritis of the fundus of the stomach)
3. Pangastritis (common gastritis of the stomach)

Diagnosis of gastritis

When you experience the first complaints, pain and/or feeling of heaviness, bloating in the abdomen, belching, sour heartburn, or feeling unwell, you should immediately consult a doctor, because gastritis can be complicated by peptic ulcers and even stomach cancer.

First of all, the doctor finds out the nature of the complaints, their duration, the nature of the diet, and the presence of stressful situations.

In order to make a morphological diagnosis of gastritis, as well as to establish whether it is associated with Helicobacter pylori, it is necessary to conduct a number of diagnostic studies, such as: endoscopic examination, ph-metry (can be performed during an endoscopic examination or as a separate procedure), urease test for Helicobacter pylori, PCR of the gastric and duodenal mucosa, blood ELISA to determine antibodies to Helicobacter pylori.

The most important method in diagnosing gastritis is endoscopic examination , in which a special probe (endoscope) equipped with a video camera is inserted into the stomach and duodenum, with which the stomach and duodenum are examined. From the most changed areas during endoscopy, a biopsy (a piece of tissue) is taken for histological examination (a method that examines the structure of the tissue to exclude cancers and precancerous diseases of the stomach). It is also possible to perform ph-metry (measuring the acidity of the stomach contents) during endoscopy. It is the endoscopic method that determines the morphology of the mucosa, the degree of its damage, the depth of the damage and the localization of the pathological process.

Breathing is also widely used urease test for Helicobacter pylori. Helicobacterрylorі in the process of life produces urease (a special enzyme that accelerates the processing of urea into ammonia and carbon dioxide). This method, using a special device, allows you to compare the levels of gas composition in the original, normal version and with high urease activity.

To determine whether an organism is infected with Helicobacter pylori, you can use the method PCR diagnostics (polymerase chain reaction) - determination of Helicobacter рylor DNA sections in a biopsy sample of the gastric and duodenal mucosa. And ELISA diagnostics - an enzyme-linked immunosorbent test that determines the presence of IgA, IgM and IgG antibodies (immunoglobulins) to Helicobacter pylori in the blood. IgA and IgM indicate early infection (appear a few days after infection), and IgG indicate late infection (appear a month after infection).

Diagnosis of autoimmune gastritis includes the detection of antibodies to pariatal cells of the stomach, carried out by ELISA diagnostics.

Treatment of acute gastritis

To cleanse the stomach, give the patient 2-3 glasses of water and induce vomiting. In case of chemical poisoning, gastric lavage is carried out using a thick gastric tube. Washing is carried out until the wash water is clean. During the first two days, no food is taken and a water-tea diet is prescribed. Then the diet is expanded, including slimy soups and cereals, jelly, white flour crackers, and soft-boiled eggs.

To eliminate pain, antispasmodics (for example, no-spa) and antacids (for example, Gaviscon, Rennie) are used; enterosorbents are recommended; prokinetics are prescribed for vomiting. For acute toxicoinfectious gastritis, antibiotics are needed.

Treatment of chronic gastritis

In the treatment of gastritis, much attention should be paid to lifestyle changes, try to avoid stress, follow a daily routine, get rid of bad habits (smoking, drinking alcohol), and of course follow dietary recommendations:

• For patients with gastritis, it is necessary to exclude fried foods, rich meat and fish broths, do not overeat, eat 5-6 times a day
• Do not consume foods that contribute to heartburn: strong tea, coffee, chocolate, carbonated drinks, alcohol, onion, garlic, butter
• Consume boiled meat, boiled fish, steamed food, pureed cereal soups (rolled oats, rice)
• Eat less cabbage, legumes, milk - foods that promote flatulence

Treatment of chronic gastritis with medications

- When stomach acidity is increased -

If a patient has gastritis with increased secretory activity, therapy for gastritis includes drugs that reduce gastric acidity, the so-called proton pump inhibitors.

They share five generations

1. Omeprazole (Omez)
2. Lansoprazole (Lanzap),
3. Pantoprazole (Nolpaza, Zypantol)
4. Rabeprazole (Pariet)
5. Esomeprazole (Nexium)

As well as antacid drugs (Gaviscon, Rennie, Almagel, Maalox). It is preferable to use preparations containing carbonates and not containing aluminum (Gaviscon, Rennie).

Antacids are first aid medications in case of heartburn in a patient If it is difficult to see a doctor at the moment, the patient can take an antacid on his own.

Physiotherapy

For gastritis with increased secretion, it is recommended to use amplipulse therapy and a microwave electromagnetic field. Physiotherapy is carried out only during the period of remission.

Treatment with folk remedies

For gastritis with increased secretion, it is recommended to drink herbal decoctions that have an enveloping, protective effect. Such herbal remedies include flax seeds, burdock root, coltsfoot leaves, calendula flowers, chamomile flowers. Medicinal raw materials are infused, take 2 tbsp. l. 4 times a day 10-15 minutes before meals.

From mineral waters, you can use low-mineralized alkaline waters: Borjomi, Slavyanskaya, Smirnovskaya. It should be consumed warm (the water is heated to remove excess carbon dioxide, which stimulates the secretion of gastric juice), degassed in ¾ cup 3 times a day an hour before meals.

- When stomach acidity is reduced -

For gastritis with reduced secretion, the gastroprotective drug Bismuth tripotassium citrate (De-nol) is used. Replacement therapy is also indicated: gastric juice, pepsidil, acidin pepsin, bitterness (tincture of dandelion root, tincture of wormwood herb).

Physiotherapy

Galvanization, electrophoresis of calcium and chlorine enhances the secretion of gastric juice.

Treatment with folk remedies

To increase the acidity of gastric juice, use: cabbage juice, apple juice, or grated apple, as well as grated pumpkin and raw potato juice. The goal of herbal medicine for gastritis with low acidity is to stimulate the secretion of gastric juice and also relieve inflammation.

The following medicinal plants are used: rhizomes of calamus, calendula flowers, chamomile flowers, yarrow herb, dandelion flowers, large plantain leaves. The herbs must be crushed, dosed (1 teaspoon of each herb), mixed, and the medicine prepared. Pour a tablespoon of the mixture into a glass of boiling water, heat in a water bath for 15 minutes, leave until it cools (about 45 minutes), add boiled water to the initial volume, take 2 tbsp. l. 4 times a day

You can also use tincture of wormwood herb, 15-20 drops 20 minutes before meals. This bitter tincture will stimulate the secretory function of the stomach.

For gastritis with low acidity, mineral waters are also used for treatment. In this case, there is no need to heat the water. You need to drink water slowly ¾ glass 20 minutes before meals. It is best to use “Essentuki-4”, “Essentuki-17”.

Treatment of Helicobacter pylori chronic gastritis

If tests are positive for Helicobacter pylori, a weekly triple treatment regimen, or “quadruple therapy,” is prescribed. Treatment regimens are selected for each patient by the attending physician.

A triple weekly treatment regimen includes the use of a combination of antibiotics sensitive to Helicobacter pylori, as well as proton pump inhibitors. Quadruple therapy - antibiotics, antibacterial agents, proton pump inhibitors, gastroprotectors.

After a month or two, it is necessary to take a repeat test for Helicobacter pylori, and if the result is positive, decide on the issue of repeated anti-Helicobacter therapy, taking into account the patient’s complaints.

Treatment of autoimmune gastritis

In the initial and progressive stages of the disease with preserved secretory function of the stomach, with a serious disruption of immune processes, glucocorticosteroid hormones are prescribed (short courses).

At the stage of stabilization of the process, in the absence of clinical manifestations, the patient does not need treatment.

Treatment of chronic reflux gastritis

To prevent the reflux of stomach contents into the esophagus, prokinetics are prescribed - drugs to improve gastrointestinal motility (for example, Trimedat, Motilium).

Be healthy!

Therapist Evgenia Anatolyevna Kuznetsova

Taking a general blood test for gastritis is not enough to confirm or refute the fact of the disease. If a person begins to feel uneasy, has a stomach ache, a fever and other signs are observed, he needs to think about a comprehensive examination. The research must be timely and professional. Therefore, it is better to take even general blood tests for gastritis in well-established clinics or doctors you trust.

To diagnose gastritis, not only gastroscopy is used, but also additional tests.

Sequencing

There are different tests for gastritis, each of which is focused on certain indicators and should be part of a group of methods for identifying the disease. Your doctor will decide which tests you may need. To do this, before the examination, the specialist collects an anamnesis.

Although this is a normal conversation between doctor and patient, a lot of useful information can be obtained from taking an anamnesis. A specialist can find out why attacks occur and worsen. Additionally, a physical examination method is carried out, that is, palpation of the abdomen, study of the current condition of the patient’s throat and tongue, as well. Next, it is necessary to determine a set of measures aimed at confirming the diagnosis and excluding other diseases that occur with similar symptoms.

The mandatory list of tests includes:

• blood (general analysis);
• stool analysis;
• urine;
• biochemical blood test;
• Helicobacter;
• gastric juice.

If there is a suspicion of, then tests should be taken to identify potentially pathogenic microorganisms that can cause intoxication in the body. These include shigella, salmonella, staphylococci, etc. It is possible to determine what tests patients undergo for gastritis only on an individual basis.

A set of measures aimed at determining the characteristics of the disease and confirming the diagnosis can be divided into two groups:

• laboratory;
• instrumental.

Each of them plays an important role and is able to find answers to questions that interest the doctor and his patient.

Laboratory group

This includes not only a blood test for gastritis, but also a number of other methods for examining samples from a patient with suspected disease. Laboratory tests include blood, urine, feces, detection of Helicobacter and special studies to exclude other diseases.

Breath analysis

It is worth considering separately. This is a worthy alternative to FGS, in which the patient has to deal with unpleasant sensations from the penetration of a special probe into the body. Yes, today it is considered the most informative and effective among all methods for diagnosing gastritis. But a number of people have contraindications to this procedure, which is why they have to look for other methods. One of them was a breath test. The idea is to collect two samples of the contents that the patient exhales. For this purpose, special plastic tubes are used. You need to breathe for several minutes. It is important to prevent saliva from getting into the tube.

To ensure that the test is correct and there are no false results, several rules are followed:

• breath tests are taken only in the morning before meals;
• There should be no cigarettes or even chewing gum to freshen your breath before the analysis;
• exclude all legumes from the diet the day before the test;
• stop taking medications of antibacterial and antisecretory groups two weeks before;
• exclude analgesics before the study;
• Before visiting the laboratory, thoroughly clean your teeth and rinse your mouth.

The sensitivity of this test is about 95%.

Instrumental group

They use special equipment and medical instruments. Basically, such methods are relevant for examining patients with chronic gastritis.

Many people are afraid of the FGDS procedure. But in reality, gastroscopy is not as painful and unpleasant as some people think. The patient experiences minimal discomfort and receives complete information about the state of his health. Yes, if there are contraindications to the procedure, you should abandon it and look for alternative methods. Try to seek help as early as possible at the first suspicion of gastritis. Getting tested is not difficult, but early detection of the disease will help solve the problem quickly and painlessly. Further complications of gastritis entail a serious threat to health and life.

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CHRONIC GASTRITIS

ICD code – 10K-29

The purpose of the lecture is Based on the knowledge gained, make a diagnosis of chronic gastritis, make a differential diagnosis, formulate a diagnosis and prescribe a treatment regimen for a specific patient with chronic gastritis.

Lecture outline

Clinical case

Definition of chronic gastritis

Epidemiology of chronic gastritis

Etiology and pathogenesis of chronic gastritis

Clinical picture of chronic gastritis

Laboratory and instrumental diagnosis of chronic gastritis

Diagnostic criteria for chronic gastritis

Differential diagnosis of chronic gastritis

Classification of chronic gastritis

Treatment of chronic gastritis

Prognosis for chronic gastritis

Clinical case:

Demonstration of patient A., 28 years old, who was admitted to the clinic with complaints of constant pain in the epigastric region, worsening on an empty stomach, a feeling of heaviness in the epigastrium, nausea, loss of appetite and weight loss of about 4 kg over the past 1.5-2 months.

He considers himself sick for about 10 years, when pain in the epigastric region first appeared, without a clear connection with food intake, nausea, the urge to vomit, and occasional heartburn after errors in the diet. The pain was somewhat relieved after drinking soda or alkaline mineral water. At the local clinic, an X-ray examination of the stomach was performed, which revealed: on an empty stomach a significant amount of fluid, thickening of the folds, live peristalsis, the duodenal bulb was not changed. She was treated on an outpatient basis with gastrocepin, but-spa with a short-term effect. Subsequently, the pain resumed after a violation of the diet (spicy, fried, fatty), there was no clear seasonality of exacerbations. The real exacerbation lasted for about 2 months, when, after breaking the diet, pain in the epigastric region resumed, heartburn and sour belching appeared, later nausea and the urge to vomit appeared, appetite disappeared, and I lost about 4 kg in weight during the exacerbation. She was admitted to the clinic for examination and treatment.

On admission: condition was satisfactory. The food has been slightly reduced. Breathing is vesicular, heart sounds are clear and rhythmic. BP-110/70mmHg, pulse 68 beats. per minute On palpation, the abdomen is soft, painful in the epigastric and pyloroduodenal areas, the liver and spleen are not enlarged.

During the examination: Er. - 4.4 T/l, NV - 127 g/l, Leuk - 6.7 G/l., blood count without features, ESR - 11 mm/hour. A stool occult blood test is negative.

With pH measurements, basal secretion is 1.5, after stimulation - 1.2 (significantly increased).

With FGDS: the esophagus is unchanged, the cardia closes completely. The gastric mucosa is hyperemic; on an empty stomach there is a lot of clear liquid and mucus in the stomach. The folds of the mucous membrane are sharply thickened and convoluted; in the antrum there are submucosal hemorrhages and flat erosions. The duodenal bulb is not changed. A biopsy was taken from the antrum of the stomach: mucosal hyperplasia, the basement membrane is not changed, in some places there are accumulations of lymphoid elements, as well as foci of intestinal hyperplasia. Many Helicobacter pylori on the surface and in the depths of the pits.

Preliminary diagnosis: chronic gastritis associated with

Helicobacter pylori.

Definition of the concept

Chronic gastritis (CG) is a chronic inflammation of the gastric mucosa, manifested by its cellular infiltration, disruption of normal regeneration processes, gradual development of atrophy of the glandular epithelium, intestinal metaplasia, disorder of the secretory, motor and endocrine functions of the stomach.

Epidemiology of chronic hepatitis

In countries with developed statistics, chronic gastritis accounts for 80–90% of diseases of the stomach itself. CG is the most common disease of the digestive system and in most cases precedes and accompanies such clinically and prognostically serious diseases as ulcers and stomach cancer. The incidence of CG increases with age.

Etiology

CG is a polyetiological disease.

There are two groups of etiological factors of CG – exogenous and endogenous.

Exogenous factors

infection with Helicobakter pylori (Hp);

nutritional factors (rough, spicy foods);

alcohol abuse;

• long-term use of medications that irritate the gastric mucosa;

  exposure to chemical agents on coolant;

  exposure to radiation;

  other bacteria (except Hp);

Endogenous factors, contributing to the occurrence of CG:

genetic factors;

duodenogastric reflux;

autoimmune factors;

endogenous intoxications;

hypoxemia;

chronic infection;

metabolic disorders;

endocrine dysfunctions;

hypovitaminosis;

reflex effects on the stomach from other affected organs.

Let's return to our patient. Please note that in the given case of the patient’s medical history, an exogenous etiological factor was identified: Helicobacter pylori (Hp).

The most significant etiological factors:

Helicobacter pylori infection, which accounts for the majority of cases of chronic hepatitis (85-90%).

History of the discovery of Helicobacter pylori.

In 1875, German scientists discovered a spiral-shaped bacterium in the lining of the human stomach. This bacterium did not grow in culture (on artificial nutrient media known at that time), and this accidental discovery was forgotten.

In 1899, Polish professor Valery Jaworski from the University of Krakow, examining the lavage waters of the human stomach, discovered bacteria with a characteristic spiral shape. He was the first to suggest the possible etiological role of this microorganism in the pathogenesis of gastric diseases. However, this work did not have much influence on the rest of the medical and scientific world, since it was written in Polish.

In 1974, Professor I. A. Morozov from Moscow discovered spiral-shaped bacteria in the material of patients after vagotomy in stomach cells. However, the method of growing these bacteria was not known to microbiologists, and the found bacteria were simply forgotten for almost ten years.

The bacterium was rediscovered in 1979 by Australian pathologist Robin Warren, who then carried out further research on it with Barry Marshall. They were also the first to succeed in cultivating this microorganism on artificial nutrient media. Warren and Marshall suggested that most stomach ulcers and gastritis in humans are caused by infection with a microorganism Helicobacter pylori, and not stress or spicy food, as previously assumed.

One of the most convincing experiments in this area was carried out by Barry Marshall: he deliberately drank the contents of a Petri dish containing a culture of bacteria. H. pylori, after which he developed gastritis. The bacterium was found in the lining of his stomach. Marshall was then able to demonstrate that he was able to cure his Helicobacter pylori gastritis with a 14-day course of treatment with bismuth salts and metronidazole.

In 2005, the discoverers of the bacterium's medical significance, Robin Warren and Barry Marshall, were awarded the Nobel Prize.

The optimal acidity for the life activity of HP is pH from 3.0 to 6.0, which determines its main localization in the antrum of the stomach. As acidity increases, HP migrates to the duodenum. When acidity decreases, HP migrates to the area of ​​the body and fundus of the stomach. The main consequences of the effect of HP on the gastric mucosa (GMU):

primary contact damage to epithelial cells;

initiation of the inflammatory cascade in the gastric mucosa in the form of activation of cellular elements causing secondary damage to epithelial cells;

an increase in the production of gastrin by G-cells and, accordingly, hydrochloric acid and pepsin by parietal cells;

pronounced disruption of cellular regeneration processes.

Helicobacter pylori colonies in the gastric mucosa

Nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs with long-term use cause severe damage to the gastric mucosa, mainly the antrum and duodenum (hemorrhages, erosions, ulcers). Side effects of NSAIDs are associated with their ability to inhibit the key enzyme in arachidonic acid metabolism, cyclooxygenase (COX), which leads to inhibition of prostaglandin synthesis. Prostaglandins, in turn, determine the most important physiological reactions of the body, incl. the speed of reparative processes in the coolant and duodenum (duodenum).

Duodenogastric reflux (DGR) in approximately 15% of cases it is the cause of the development of hCG. DHR is caused by insufficiency of the pyloric closure function, chronic duodenitis and increased pressure in the duodenum. DGR leads to damage to the coolant, mainly the antrum, by bile acids, their salts, pancreatic enzymes, lysolecithin and other components of the duodenal contents.

Autoimmune mechanisms account for 5% of the causes of CG development.

The formation of autoimmune atrophic CG is based on the formation of antibodies to the parietal (parietal) cells of the fundus of the stomach. As a result of this formation, the following occurs:

decreased production of hydrochloric acid and pepsin (hypochlorhydria, achlorhydria and achylia);

atrophy of the coolant, mainly in the fundus;

decreased production of intrinsic factor Castle and the development of B12-deficiency anemia;

increased gastrin production by G-cells in the antrum of the stomach.

Pathogenesis of chronic gastritis

The impact of etiological factors leads to disruption regeneration gastric mucosa suppression differentiation cells to the development of functionally immature epithelial cells that are less resistant to damage and die earlier from harmful influences. Gradually developing atrophic changes in the mucosa.

Clinical picture of hCG

Main syndromes in chronic hepatitis

1. Pain syndrome

2. Gastric dyspepsia syndrome

3. Changes in the general condition and other organs.

The severity and nature of symptoms in chronic hepatitis depends on:

Stages of the disease

Secretory function of the stomach,

Localization of the inflammatory process.

Pain syndrome in case of CG of the gastric body type A is reduced mainly to dull, low-intensity pain in the epigastric region that occurs during or shortly after eating.

Pain syndrome with chronic hepatitis B type.

The pain is most often in the right half of the epigastrium. Cause of pain: irritation

pyloroduodenal zone with acidic gastric contents. The pain is late, hungry in nature, occurs 1.5-2 hours after eating and is relieved by taking antacids (so-called “ulcer-like dyspepsia”).

Pain in the epigastric region with reflux gastritis type C is pressing in nature, quite intense, occurs 40 minutes after eating and is often accompanied by belching and a feeling of bitterness in the mouth.

Syndrome of gastric dyspepsia in chronic hepatitis with secretory insufficiency:

Decreased appetite;

Nausea after eating;

Vomiting, which brings relief;

Belching, sour, eaten food;

Gastric discomfort (heaviness, bloating, pressure in the upper abdomen after eating).

Syndrome of gastric dyspepsia in chronic hepatitis with hypersecretion:

Persistent, painful heartburn, which is the result of regurgitation of acidic contents into the esophagus. Sometimes heartburn is the equivalent of pain and appears 1.5-3 hours after eating.

Sour belching.

Changes in the general condition during chronic hepatitis from other internal organs:

Decreased appetite, weight loss, asthenic syndrome, irritability.

Development of B-12 deficiency anemia (with hCG type A), hypovitaminosis C.

intestinal dyspepsia: intestinal discomfort, rumbling, flatulence.

Stool instability:

diarrhea due to chronic hepatitis with insufficiency of secretion

constipation in chronic hepatitis with increased gastric secretion.

Our patient, whose history was presented at the beginning of the lecture, had complaints of constant pain in the epigastric region, worsening on an empty stomach (“ulcer-like dyspepsia”), a feeling of heaviness in the epigastrium, nausea, and decreased appetite (gastric dyspepsia syndrome). In addition, changes in other organs and systems were identified: she lost 4 kg over the past 1.5-2 months.

Determines the effectiveness and correctness of the chosen treatment regimen. But identifying the disease is difficult due to its similarity with other pathologies of the gastrointestinal tract and the body as a whole. Therefore, for diagnostic purposes, an integrated approach is used, starting from a conversation and assessment of the patient’s complaints up to minimally invasive operations. Diagnostics are carried out according to the plan given below. The methods used are used to determine pathology in children.

Inspection

The gastroenterologist begins the examination by collecting the patient’s family history and medical history. This allows you to determine the cause of an exacerbation or attack. Subsequently, the area of ​​projection of the stomach is palpated. With gastritis, the pain will increase with pressure.

A physical examination is relevant when determining acute corrosive inflammation that has arisen against the background of chemical poisoning. Due to extensive burns of the mouth and esophagus, when acids or alkalis are swallowed, erosions and areas of necrosis appear around the mouth and in the cavity. White scabs occur with burns with hydrochloric acid, yellow with nitric acid, black with sulfuric acid, and brown-gray with alkali. At this stage, other signs are taken into account:

• general weakness;
• abdominal muscle tension;
• the presence of vomiting and the appearance of the vomit.

Laboratory methods for examining chronic gastritis

An adult patient or child must undergo general and specific tests:

1. Test for general blood parameters. Gastritis can be suspected by detecting low hemoglobin, platelets, erythrocytes, leukocytes with an increased ESR.
2. Laboratory evaluation of stool for the presence of occult blood and Helicobacter. This test determines the amount of acidity that can cause poor digestion.
3. General urine test. It is done for prevention and allows you to detect underlying diseases and the presence of a secondary infection.
4. Biochemistry analysis. The method allows you to differentiate gastritis from pancreatic diseases and identify the presence of Helicobacter. In case of Helicobacter pylori infection, the blood will show normal values ​​for the parameters being studied. If there is autoimmune chronic gastritis, hyperbilirubinemia is determined, which is confirmed by anemia due to vitamin B12 deficiency, a decrease in protein content, and a jump in gamma globulins.
5. Specific tests. They are carried out to detect other microbes that have caused intoxication of the body, such as salmonella, staphylococcus, shigella. Tests are carried out for the concentration of protein and its fractions in plasma, calculation of pepsinogen in the blood and digestive juice, determination of the activity of alkaline phosphatases, transaminases, concentrations of electrolytes such as potassium, sodium, calcium.
6. Bacteriological analysis.
7. Immunological research.

Instrumental methods

For these purposes, various equipment and tools are used. A broader complex is used for chronic inflammation than for acute inflammation. In the latter case, the main method is examination, since the manifestations are more pronounced in children and adults.

FGDS

Fibrogastroduodenoscopy is one of the main diagnostic methods included in the group of endoscopic ones. Tools:

• a probe in the form of a thin flexible tube;
• mini camera on the probe;
• a monitor on which the information received by the camera is visualized.

The examination requires inserting a probe into the digestive organ through the mouth and esophagus. FGDS determines:

• location of inflamed foci in the gastric walls;
• type, nature, stage of membrane damage;
• excludes peptic ulcer disease.

Simultaneously with the stomach, the duodenum is examined, which is often also affected by gastritis. Endoscopic examination results:

1. When the mucosa is shiny with fibrin plaque, which is hyperemic and edematous with foci of hemorrhage, non-atrophic or superficial gastritis is diagnosed.
2. With severe thinning of the membrane with a smoothed relief, gray color and translucent choroid plexuses, atrophic gastritis is determined. The disease is considered moderate if thinning areas alternate with small areas of white atrophy of varying shapes. If atrophy has reached the last stage, a sharp thinning of the mucous membrane of a cyanotic hue is visualized, which is easy to wound with a simple touch. In this case, folds are not detected.
3. With an enlarged pylorus, hyperemic and edematous mucosa, and a significant amount of bile in the stomach, reactive gastritis resulting from chemical poisoning is diagnosed.
4. Multiple or single erosive areas form on the mucous membrane during drug-induced gastritis.
5. If large folds, similar to the convolutions of the brain, and excessive amounts of mucus are found in the stomach, hypertrophic gastritis is diagnosed. The shell can be easily damaged. Erosions often bleed.

Biopsy

Produced during FGDS. A special probe is used to remove a piece of affected tissue from the walls of the stomach of a child or adult for laboratory testing. The samples are taken from different parts of the stomach. This makes it possible to more accurately determine or refute the presence of Helicobacter, the activity of which is different in different parts of the organ. For this purpose, 2 biopsies are taken from the antrum and the body of the digestive organ. The Helicobacter test is performed using 4 methods:

• bacteriological;
• morphological, which includes the determination of cytology, tissue histology;
• reduced biochemical;
• immunohistochemical.

It is known that gastritis is an acid-dependent pathology, so an analysis is required to determine the acid content in gastric juice. For these purposes, pH measurement is used, which is classified as:

1. Express test is a probe method for measuring acid in the stomach with special electrodes.
2. 24-hour pH-metry, which allows you to evaluate the dynamics of fluctuations in acidity levels in two ways:
   • tube, carried out by introducing a nasogastric tube into the digestive organ;
   • probeless, which involves swallowing a capsule, which is attached to the wall of the stomach to transmit information to the acidogastrometer, and then removed from the body naturally;
   • endoscopic pH-metry, which involves taking and analyzing a biopsy sample during FGDS.

Gastric juice assessment

Gastric contents are collected during gastroscopy. Beforehand, an adult or child needs to take a special breakfast with components that stimulate the secretion of digestive juice. The method allows you to determine the cause of inflammation of the walls of the organ. For example, an increased gastrin content indicates the presence of Helicobacter bacteria in the body. Focal gastritis with tissue atrophy is characterized by reduced acidity, decreased activity of pepsin and gastricsin. A strong change in these parameters indicates severe atrophy. Antral gastritis is manifested by three types of secretion:

• hyperreactive;
• hyperparietal;
• panhyperchlorhydric.

But the excess of gastric juice components is not as pronounced as with duodenal ulcerative lesions.

X-ray

Fluoroscopy is performed using a special contrast agent, which the patient must drink before the examination. The method allows you to determine the degree of change in the outline, relief, tone and shape of the organ, detect foci of inflammation and differentiate gastritis from ulcers. It is not recommended for children under three years of age.

Indicative is the double contrast method, which is applicable to children and adults. Barium and air are used as contrast. As the gastrointestinal tract fills, the gastric mucosa carefully straightens, which makes it possible to detect pathology located in the lumen. Additionally, the gastric capacity of the child and adult is assessed.